Provider Demographics
NPI:1417366220
Name:RODRIGUEZ, DIANA NA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:NA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:NA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:709 S 5TH ST
Mailing Address - Street 2:FORT PIRECE
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-8339
Mailing Address - Country:US
Mailing Address - Phone:772-467-3097
Mailing Address - Fax:
Practice Address - Street 1:709 S 5TH ST
Practice Address - Street 2:FORT PIRECE
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-8339
Practice Address - Country:US
Practice Address - Phone:772-467-3097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health